In a recent email from one of our Dark Daily readers, we were asked to cover the important question: Is total laboratory automation (TLA) or middleware the right way to go? As existing lab practices are becoming automated and old methods obsolete, many laboratories are facing this question.

An article about middleware was featured in the September 26, 2006 Dark Report. Laboratory automation and middleware are frequently covered in The Dark Report and we encourage subscribers to browse through The Dark Report archive for past issues with articles of interest on this topic and others.

Total laboratory automation, when properly implemented, has been proven to reduce overall laboratory expenses, enhance patient services, and address overall concerns facing laboratories today, such as job satisfaction, decreased length of stay, and safety. Financial savings realized are primarily a result of labor reductions. In the study, The Role of Total Laboratory Automation in a Consolidated Laboratory Network, the successful creation of a new core laboratory for the North Shore-Long Island Health System on Long Island, New York, is detailed. It should be noted that this particular laboratory facility was built from the ground up, and total laboratory automation was a logical choice because there was no cost of upgrading equipment. Paying a bit more upfront to get a totally automated set-up was a more clear-cut decision.

Middleware (also known as data management software or expert decision-making software) can provide many of the same benefits of TLA, on a somewhat smaller scale. Effective use of middleware can provide an efficient system that decreases turnaround time, allows staff to focus on critical patient results for rapid response to clinicians, reduces potential for medical errors, improves patient safety, and eliminates process delays to create a "queueless" lab with efficient sample tracking. Middleware adequately mediates between laboratory instruments and the laboratory information system. It is a "patch" of sorts to bring an older laboratory up-to-date. We found an excellent article by Ron Berman about "Maximizing the Benefits of Lab Automation Systems with Advanced Middleware" that will certainly be of interest to our readers.

Now, to address the question. Based on our research, case studies, and site visits to laboratories in many countries around the world, there are examples of laboratories that chose to implement total laboratory automation and are satisfied with the results of this decision. Unfortunately, not every lab can be upgraded into a new, custom-designed facility and not all existing labs are successful in persuading their board of directors that the costs of upgrading to a totally automated facility are worth the benefits. For older laboratories with limited funding, or new laboratories getting their start with limited funding and/or used laboratory equipment, middleware is provides an effective option. 

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